Fatih ÖZTÜRK, Kudret Atakan TEKİN, Mehmet Erdem TOKER

Açık Kalp Cerrahisinde İntraaortik Balon Pompası Kullanımı: Preoperatif, İntraoperatif ve Postoperatif Dönemlere Ait İmplantasyon Sonuçlarının Karşılaştırılması

Giriş: Açık kalp ameliyatı gerekli hastalarda kullanılan ve halen en yaygın mekanik destek cihazı olan intra aortik balon pompasının (IABP) yerleştirilme zamanlaması konusunda yerleşmiş kesin bir konsensüs yoktur. Bu çalışmanın amacı; açık kalp cerrahisi geçiren hastalarda IABP’nin preoperatif, intraoperatif ve postope ratif; üç ayrı periodda yerleştirilmesine ait sonuçlarının incelenmesi ve üç döneme ait sonuçların birbirleri ile karşılaştırılmasıdır. Hastalar ve Yöntem: Bu çalışmaya Ocak 2014 ile Aralık 2016 tarihleri arasında IABP desteği ile açık kalp cerrahisi yapılan 193 hasta dahil edildi. Hastalar İABP desteğinin başlandığı döneme göre; preoperatif dönem, intraoperatif dönem ve postoperatif dönem olarak 3 ayrı gruba ayrıldı. Hastalar; preoperatif özellikler, operatif veriler ve postoperatif sonuçlar açısından diğer gruplarla karşılaştırmalı olarak değerlendirildi. Bulgular: 193 hastanın: 32’si (%16.5) preoperatif, 64’ü (%33.1) intraoperatif ve 97’si (%50.2) postoperatif İABP desteğine alınmış hastalardır. Yoğun bakımda kalış süresi postoperatif grupta (20.15 ± 23 gün), preo peratif (7.63 ± 9.8 gün) ve intraoperatif (12.98 ± 25 gün) gruplara göre daha uzundu (sırasıyla p1: 0.005; p2: 0.007, p< 0.05). Preoperatif, intraoperatif ve postoperatif gruplarda yeni diyaliz insidans oranı sırasıyla %9.4, %23.4 ve %33 iken venoarterial ekstrakorpo real membran oksijenasyonu implantasyon oranı yine sırasıyla %3.1, %23.4 ve %22.7 idi. Preoperatif grubunda hastane mortalitesi görülme oranı (%25.0) intraoperatif (%54.7) ve postoperatif2 (%70.1) gruplarından anlamlı düzeyde düşük bulunmuştur (sırasıyla p1: 0.011; p2: 0.000, p< 0.05). Sonuç: IABP takılmasındaki gecikme hemodinamik bozulmanın ilerlemesine neden olabilir. Gerekliliğe ilişkin endikasyonu belirlemek dahi bazı hastalarda zor olabilir. IABP desteği ikinci bir inotropik desteğe ihtiyaç duyulduğunda ve hastanın CPB’den ayrılmakta güçlük çektiği intraoperatif dönemde gecik meden başlatılmalıdır.

Intraaortic Balloon Pump in Open Heart Surgery: Comparisons of the Results Obtained in the Preoperative, Intraoperative and Postoperative Implantations Periods

Introduction: No exact consensus exists on the timing of the placement of an intraaortic balloon pump (IABP), yet still, it is the most common mechanical support device used in patients requiring open heart surgery. The purpose of this study was to investigate the results of the implantation of IABP in three different periods as preoperative, intraoperative, and postoperative and to compare the results obtained in these periods. Patients and Methods: This study included 193 patients undergoing open-heart surgery with IABP support between January 2014 and December 2016. The patients were divided into three groups as preoperative pe riod, intraoperative period and postoperative period, based on the beginning of IABP support. The patients were compared in terms of preoperative characteristics, surgical data and postoperative results. Results: Of the 193 patients, 32 (16.5%) received preoperative, 64 (33.1%) intraoperative, and 97 (50.2%) postoperative IABP support. The length of ICU stay (20.15 ± 23 days) was longer for the postoperative group compared with the preoperative (7.63 ± 9.8 days) and intraoperative (12.98 ± 25 days) groups (p1: 0.005; p2: 0.007 respectively, p< 0.05). The new dialysis incidence rate in the pre-, intra-, and postoperative periods was 9.4%, 23.4%, and 33.0%, respectively. The veno-arterial extracorporeal membrane oxygenation implantation rate in the preoperative, intraoperative, and postoperative groups was 3.1%, 23.4%, and 22.7%, respectively. The incidence of hospital mortality was 25.0% in the preoperative group, which was significantly lower com pared to the intraoperative (54.7%) and the postoperative groups (70.1%) (p1: 0.011; p2: 0.000 respectively, p< 0.05). Conclusion: Any delay in insertion of IABP may cause progressive hemodinamic deteoriation. Determining the indication of implantation may even be difficult in some clinical scenarios. IABP support should be started without delay in the intraoperative period when a second inotropic support is needed and the patient has dif ficulty in weaning from CPB.

PDF

___

1. Beckmann A, Funkat AK, Lewandowski J, Frie M, Ernst M, Hekmat K, et al. Cardiac surgery in Germany during 2014: a report on behalf of the Ger man Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 2015;63:258-69.
2. Böning A, Buschbeck S, Roth P, Scheibelhut C, Bödeker RH, Brück M, et al. IABP before cardiac surgery: clinical benefit compared to intraopera tive implantation. Perfusion 2013;28(2):103-8.
3. Baskett RJ, Ghali WA, Maitland A, Hirsch GM. The intraaortic balloon pump in cardiac surgery. Ann Thorac Surg 2002;74:1276-87.
4. Creswell LL, Rosenbloom M, Cox JL, Ferguson TB, Kouchoukos NT, Spray TL, et al. Intraaortic balloon counterpulsation: patterns of usage and outcome in cardiac surgery patients. The Ann Thorac Surg 1992;54:11-20.
5. Khorsandi M, Dougherty S, Bouamra O, Pai V, Curry P, Tsui S, et al. Extra-corporeal membrane oxygenation for refractory cardiogenic shock after adult cardiac surgery: a systematic review and meta-analysis. J Car diothorac Surg 2017;12:55.
6. Kucuker A, Cetin L, Kucuker SA, Gokcimen M, Hidiroglu M, Kunt A, et al. Single-centre experience with perioperative use of intraaortic balloon pump in cardiac surgery. Heart Lung Circ 2014;23:475-81.
7. Parissis H, Leotsinidis M, Akbar MT, Apostolakis E, Dougenis D. The need for intra aortic balloon pump support following open heart surgery: risk analysis and outcome. J Cardiothorac Surg 2010;5:20.
8. Poirier Y, Voisine P, Plourde G, Rimac G, Perez AB, Costerousse O, et al. Efficacy and safety of preoperative intra-aortic balloon pump use in pa tients undergoing cardiac surgery: a systematic review and meta-analysis. Int J Cardiol 2016;207:67-79.
9. Ramnarine IR, Grayson AD, Dihmis WC, Mediratta NK, Fabri BM, Chal mers JA. Timing of intra-aortic balloon pump support and 1-year survival. Eur J Cardiothorac Surg 2015;27:887-92.
10. Zaky SS, Hanna AH, Esa WAS, Xu M, Lober C, Sessler DI, et al. An 11- year, single-institution analysis of intra-aortic balloon pump use in cardiac surgery. J Cardiothorac Vasc Anesth 2009;23:479-83.
11. Kamiya H, Schilling M, Akhyari P, Ruhparwar A, Kallenbach K, Karck M, et al. Outcome analysis for prediction of early and long-term survival in patients receiving intra-aortic balloon pumping after cardiac surgery. Gen Thorac Cardiovasc Surg 2016;64:584-91.

ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi